Benefit Comparison Summary: MEDICAL | DENTAL | VISION
Health Insurance Premiums: HEALTHCARE
COBRA | HIPAA | Care
Counsel | Employee Assistance
Eligibility | Open
Enrollment | Additional Info | Change
Flexible Spending Accounts: Health | Dependent
Care | Transit
For All Medical & Dental Plans
New Hires: If you are a regular Court employee working at least 20 hours per week, you are eligible for the Santa Barbara Superior Court sponsored group benefits. Your coverage for health and dental benefits will be effective on the first of the month after the date of hire. Eligible employees who want health and dental coverage must enroll by completing the applicable enrollment form and submitting it to the Human Resources Department upon employment prior to the second pay period of employment.
Retirees: Retirees must enroll by completing the applicable enrollment form and submitting it when they complete and return the Court’s Application for Retirement form.
Dependents: If an eligible employee or retiree wants their eligible dependents covered at the same time their initial coverage begins, the eligible dependents must be listed on the initial enrollment form. If an eligible employee or retiree acquires eligible dependents after their initial enrollment, the dependent(s) must be enrolled within 31 days of the date they are acquired. A newborn dependent child is automatically covered from birth for 31 days. In order for coverage to be continued beyond the first 31 days, a completed enrollment form must be submitted to the Court’s Human Resources Department within 31 days following the birth.
Late enrollment: If enrollment does not take place as provided above, the eligible employee or retiree may enroll themselves and/or their eligible dependents in the Court's Health and Dental Plans only during the Court’s annual open enrollment period as described, except as provided below under “special enrollment.”
Special enrollment: If an eligible employee or retiree does not enroll themselves and/or eligible dependents in the Court's Health and Dental Plan because they were covered under another group health plan or had other health insurance coverage at the time enrollment in the Plan was declined, the eligible employee or retiree may enroll themselves and/or their eligible dependents in the Plan if the following conditions are met:
- The individual’s other group health plan or health insurance coverage was terminated due to the loss of eligibility for coverage or the employer ceased making contributions for the coverage, and
- The individual requests coverage under this Plan by submitting a completed enrollment form to the Court’s Human Resources Department not later than 30 days after coverage is lost under the other plan.
If the preceding conditions are met, coverage under this Plan will begin as follows:
- For active employees - coverage begins at the beginning of the month following the date the other coverage ends.
- For retirees - coverage begins on the first day of the month following the date the other coverage ends.
Eligible employees and retirees who enroll in the Court's Health and Dental Plans may also enroll their eligible dependents in the Plans. Eligible dependents include:
- Your legal spouse
- Your legally registered domestic partner if he or she:
- Is your sole spousal equivalent (this means that you cannot be married to someone else or have another domestic partner)
- Is 18 years old or older
- Is mentally competent to enter into contracts
- Resides with you and intends to do so indefinitely
- Is jointly responsible with you for common financial obligations
- Is unmarried and not related to you by blood to a degree that would bar marriage in the state of residence
- The domestic partnership is registered with a state, county or city, and the domestic partner has not terminated another domestic partnership within the last 6 months.
- Your natural children, stepchildren, foster children placed with you by an authorized agency or by court order, and children who, before reaching the age of 18, are either adopted by you or placed in your home for adoption. In addition, such children must:
- Be under age 26
- Not be a ”qualifying child” (as that term is defined in the Internal Revenue Code) of another individual
- Your disabled children age 26 or older:
- Such disabled children must meet the same conditions as listed above for natural children, stepchildren, adopted children, or foster children, and in addition is physically or mentally handicapped on the date coverage would otherwise end because of age and continue to be handicapped.
- A child or a domestic partner who satisfies the same conditions as listed above for natural children, stepchildren, adopted children, or foster children, and in addition:
- Is not a”qualifying child” (as that term is defined in the Internal Revenue Code) of another individual
Special Rule for Divorce/Separation – The requirement that you provide over 50% of a child’s support does not apply if (i) you and the child’s other parent are divorced or legally separated under a decree of separate maintenance, are separated under a written separation agreement, or currently live apart and lived apart at all times during the last six months of the previous calendar year; (ii) the child received 50% of his or her support during the calendar year from you and the other parent; and (iii) the child is in the custody of one or both of you and the other parent more than 50% of the calendar year.
Eligible dependents do not include any person on active duty in the Armed Forces of the United States or any person covered as an employee or retiree under the Plan. If a dependent may claim dependent status by reason of a relationship to more than one eligible employee or retiree, the dependent can only be enrolled as a dependent of one of the eligible employees or retirees.
Important note: You may be required to submit on an annual basis a completed Certification of Dependents Status form for dependent children between 19 and 26 years of age.
When Coverage Begins
If enrollment takes place during the Court’s annual open enrollment period, refer to page 1 for the date coverage begins. If enrollment is delayed because of other health coverage, refer to “Special enrollment” above for the date coverage begins.
Following are the dates coverage begins when enrollment takes place when a person is first entitled to enroll.
New Hires: When enrollment requirements are met, coverage begins on the first of the month following the date of employment.
New Retirees: When the enrollment requirements are met, coverage beings on the date of retirement or, if coverage has been extended under COBRA, on the date that coverage ends.
Dependents: When enrollment requirements are met, coverage for eligible dependents begins on the date the eligible employee’s or retiree’s coverage begins or, if acquired after that date, the date the dependent becomes an eligible dependent.
When Coverage Ends
Unless a special extension applies, coverage will end on the earliest of the following dates:
- for eligible employees and their eligible dependents only, the last day of the month during which the eligible employee’s employment terminates or otherwise ceases to meet the requirements of an eligible employee;
- for retirees and their eligible dependents only, the last day of the month a retiree no longer qualifies for coverage because his retirement allowance from the Court ceases;
- for dependents only, on the last day of the month (for dependents of retirees, the last day of the month) during which the dependent no longer qualifies as an eligible dependent;
- the date of complete termination of coverage or upon the effective date of an amendment to coverage which excludes the covered person from such status;
- for a covered person who changes his dental plan selection to another dental plan provided by the Court, on the date his new dental plan selection becomes effective;
- the last day of the month following the date the Court receives written authorization from the eligible employee or retiree to terminate his health coverage. Important note to retirees: if dental coverage is voluntarily terminated by a retiree, it can not be reinstated or added at a later date, even during an annual open enrollment period;
- the last day of the month for which any required self-payment was made for this coverage if the next self-payment is not paid when due.
Physical or Mentally Handicapped Child: If a dependent child is physically or mentally handicapped on the date coverage would otherwise end because of age, the child’s coverage will be continued for as long as the eligible employee or retiree is covered provided the handicap continues and the child continues to qualify as an eligible dependent in all aspects except age. The Court may require from time to time a physicians’ statement certifying the physical or mental handicap.
Leave of Absence: Eligible employees may continue coverage during a leave of absence provided they continue bi-weekly contributions as agreed upon with the Court and they comply with the applicable provisions of the Court’s Leave of Absence Policy.
Employees entering the Armed Forces of the United States: If an eligible employee goes into active military service (including periodic reserve training) for any of the Armed Forces of the United States for up to 31 days, coverage may continue during the period of that leave, if such employee continues to pay his required contribution for coverage, if any. The Court will continue its contribution for coverage during such military leave.
If an eligible employee goes into active military service for any of the Armed Forces of the United States for more than 31 days, coverage may continue for up to 18 months or the period of such military leave, whichever is shortest, if such employee pays the full cost of the coverage during the military leave.
Whether or not an eligible employee elects to continue coverage, coverage will be reinstated on the first day he returns to active employment with the Court if he is released under honorable conditions and he returns to work on whichever of the following dates is applicable:
- on the first full business day following completion of his military service for a leave of 30 days or less,
- within 14 days of completing his military service for a leave of 31 to 180 days,
- within 90 days of completing his military service for a leave of more than 180 days.
When coverage is reinstated, all provisions, limitations and exclusions of the Plan will apply to the extent that they would have applied if he had not taken military leave and his coverage had been continuous under the Plan. The foregoing, however, does not apply to coverage for any illness or injury caused or aggravated by military service, as determined by the Veterans Administration.
Family, Medical or Personal Leave: If an eligible employee qualifies for an approved family, medical or personal leave, coverage may continue for the duration of the leave if the eligible employee pays any required contributions towards the cost of coverage. Court contribution towards the cost of employee coverage will continue for the first 18 months for an approved family or medical leave. For an approved personal leave, the Court contribution towards the cost of employee coverage will continue for the first two pay periods.
Extension of Benefits: If a dentist certifies that a covered person is undergoing a course of treatment on the date coverage ends for any reason (other than the maximum benefit has been paid), Health and Dental benefits will be continued for covered expenses directly related to the completion of the course of treatment until the earliest of:
For orthodontia – the date the maximum benefits have been paid or the date the Dental Plan is terminated;
For other covered expenses - the date the maximum benefits have been paid; 90 days following the date the covered person’s coverage terminated, or the date the coverage is terminated.
Prophylaxis and x-rays are not part of a course of treatment.
Rules for Mid-Year Event Changes
Other than during annual open enrollment, you may only make changes to your benefit elections if you experience a qualified status change or qualify for a “special enrollment”. If you experience a qualifying event change, you may be required to submit proof of the change or evidence of prior coverage.
Qualified Status Changes include:
- Change in legal marital status, including marriage, divorce, legal separation, annulment, and
death of a spouse
- Change in number of dependents, including birth, adoption, placement for adoption, or death of
a dependent child
- Change in employment status that affects benefit eligibility, including the start or termination of
employment by you, your spouse, or your dependent child
- Change in work schedule, including an increase or decrease in hours of employment by you,
your spouse, or your dependent child, including a switch between part-time and full-time
employment that affects eligibility for benefits
- Change in a child's dependent status, either newly satisfying the requirements for dependent child
status or ceasing to satisfy them
- Change in place of residence or worksite, including a change that affects the accessibility of
- Change in your health coverage or your spouse's coverage attributable to your spouse's
- Change in an individual's eligibility for Medicare or Medicaid
- A court order resulting from a divorce, legal separation, annulment, or change in legal custody
(including a Qualified Medical Child Support Order) requiring coverage for your child.
- An event that is a “special enrollment” under the Health Insurance Portability and Accountability Act (HIPAA) including acquisition of a new dependent by marriage, birth or adoption, or loss of coverage under another health insurance plan.
- An event that is allowed under the Children's Health Insurance Program (CHIP) Reauthorization Act. Under provisions of the Act, employees have 60 days after the following events to request enrollment:
Employee or dependent loses eligibility for Medicaid (known as Medi-Cal in CA) or CHIP
(known as Healthy Families in CA).
- Employee or dependent becomes eligible to participate in a premium assistance program
under Medicaid or CHIP.
Two rules apply to making changes to your benefits during the year:
- Any change you make must be consistent with the change in status, AND
- You must notify your Human Resources Department and make the change within 30 days of the date the event occurs (unless otherwise noted above).
Waiver of Coverage
Eligible employees may waive health insurance coverage by completing and submitting to the Court’s Human Resources Department a Waiver of Medical/Dental Coverage form.
This is only a summary of the eligibility requirements and is not intended to modify or supersede the requirements of the plan documents. The plan documents will govern in the event of any conflict between this summary and the plan documents.